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RECENT ADVANCES IN THE UNDERSTANDING OF POLYCYSTIC OVARIAN SYNDROME

Polycystic ovary syndrome (PCOS) is one of the major causes of infertility in Nigeria. Recent information now points to nutrition, environmental toxins, and occupational hazards are some of the reasons for this disorder. Polycystic ovary syndrome (PCOS) is a group of disorders that consists of excess androgens, menstrual irregularities, and chronic lack of ovulation. About 6% to 20% of women in the reproductive age group (15-45 years) are affected by PCOS, and sometimes it is an incidental finding during a routine transvaginal ultrasound scan. The symptom of the disorder may be observed during the teenage pubertal period like acne, male pattern of hair growth in females such as facial hair, abdomen, buttocks, and menstrual irregularities. Older women tend to present with irregular menstruation and infertility. Other symptoms of the syndrome include obesity in about 50% of PCOS women and elevated insulin levels- the hormone involved in blood sugar control. 10% of women with PCOS by age 40 are overweight and develop abnormally high blood sugar levels, whereas 35% of them develop pre-diabetes (high levels of sugar but not enough to be diabetic). Both obesity and elevated insulin levels further worsen the high androgen levels in PCOS.

 

The precise cause of PCOS is unknown, but several possible reasons could result from a combination of genetic, lifestyle, and health factors. Recent studies have now shown more light on the precise cause of PCOS. As a result of such publications and the International Environmental Committees’ report that I am a member of, we now know the fact. Endocrine-disrupting chemicals (EDCs) or endocrine disruptors are “exogenous substances or mixtures that alter function(s) of the endocrine system and consequently cause adverse effects in an intact organism or its progeny or (sub) populations.” Advanced glycation end products (AGEs) have raised one of the recent decades’ most controversial environmental questions that require urgent answers. The Western diet and lifestyle can be a significant environmental source of these toxicants that are potentially involved in the pathogenesis of PCOS. Extensive data from different scientific models collected in recent years have confirmed their damaging role in the pathophysiology of PCOS and their negative epigenetic impact (summarized in Fig. 5). Therefore, strategies and strong recommendations should be targeted to reduce human exposure to protect next generations from steadily rising adverse health effects

Processed, canned, and especially animal-derived foods are examples of sources of high exposure to both suspected environmental toxins, EDCs, and AGEs, which may lead to endocrine, metabolic, and reproductive disruption, resulting in PCOS phenotypes and adverse health effects. Other products include petrochemical products, oil fossils in the oil-producing regions such as the Niger Delta in Nigeria and some African countries like Angola. The EDC and

Genetic variations in genes cause an increase in the production of luteinizing hormones and anti-Mullerian hormones and androgen production necessary for ovulation and a decrease in genes related to follicle-stimulating hormones. These are thought to impact negatively on follicular development in women with PCOS. Other genes related to inflammatory responses, insulin production and regulation, and those associated with fat production may also contribute to PCOS development. The common risk factors for PCOS are diabetes, obesity, and sedentary (inactive lifestyle). Furthermore, about 20-40% of women with PCOS have an affected mother or sister, which is also a risk factor for developing PCOS.

The various treatment protocols include a change in diet, complete body detoxification, and IVF